Prescriber Checkup: Lifting the veil on dangerous prescribing

Published 12:00 am, Monday, May 13, 2013

Federal officials were skeptical two years ago when ProPublica asked them to release a database of prescriptions written in Medicare's landmark drug plan, known as Part D.

The data details the prescribing habits of more than 1 million doctors and other health professionals who treat Medicare patients. The Centers for Medicare and Medicaid Services had never allowed any outsider, let alone journalists, to have access to such records, which include identity codes for individual providers.

In the months that followed, ProPublica reporters argued that freeing this data could help patients assess the prescribing patterns of their health providers. The reporters pointed out that the stringent laws on the confidentiality of medical records were written to protect the privacy of patients, not doctors.

After months of high-level deliberation, CMS, to its credit, agreed to release the records -- and to unveil one of medicine's biggest secrets.

In examining the data, our reporters found powerful indications that Medicare has not done all it could to oversee its drug plan.

Some of our nation's most vulnerable citizens rely on this program -- the elderly and disabled. We found that some doctors were prescribing antipsychotic drugs to large numbers of seniors -- an age group for which such medicines are particularly hazardous. Others were writing unusually high numbers of prescriptions for painkillers and other dangerous drugs. Reporters systematically examined these cases, interviewing the doctors about their prescribing decisions. In some cases, they could explain their conduct. In others, they could not.

They all had one thing in common: None of the doctors whose prescribing habits stood out in our analysis had ever been questioned by Medicare officials. Government overseers, our reporters found, didn't consider it their job to examine these patterns or act upon them.

The story we've published with The Washington Post is the first in a series that will delve into critical gaps in government oversight of public programs that annually spend billions of dollars in taxpayer money for prescription drugs.

Officials at CMS, the agency that runs Medicare, contend the program is running smoothly. They have rebuffed calls by the Inspector General at the Department of Health and Human Services to tighten oversight of the drug program. Their own records offer a powerful rebuttal.

Beyond surfacing dangerous prescribing habits, the information we are making public with this story has the potential to change the doctor-patient relationship.

Until now, only insurance companies, government officials and pharmaceutical manufacturers have been able to track prescriptions written by individual doctors. Pharmaceutical companies have used such data to see how often doctors choose high-priced, name-brand drugs over generics, or pick one manufacturer's product over a competitor's.

The companies have bought this information from middlemen who collect it from pharmacies. Several years ago, ProPublica attempted to purchase this information from one of these companies. We were told it would not be available to us at any price.

The story and online news application, called Prescriber Checkup, put a significant chunk of that information in the hands of the public. You will be able to review the prescription patterns of nearly 350,000 Medicare providers, including the most prolific, and see how they compare to others in the same specialty.

Like all data, this information is just the starting point for a larger conversation. There are many reasons one health provider's prescribing patterns could vary from those of his or her peers. Doctors with sound approaches can stand apart if they have unusual patient populations, for example.

But the release of this information will give health professionals and patients new insights. A number of doctors we interviewed said they welcomed the chance to see where they stood.

Because this data is so potentially valuable to patients and doctors, we are making nearly all of it available immediately to researchers and the public on our website.

We expect that journalists, scholars and patients will find this information of use as the nation continues to debate the future of American health care.